Bioelectrical impedance analysis in patients with breast cancer-related lymphedema before and after lymphaticovenular anastomosis

Multifrequency electrical impedance tomography (Mf-EIT) for the detection of breast cancer phantom anomalies

Breast cancer is the most commonly diagnosed neoplasm and one of the most widespread cancers among women. The research advanced the Mf-EIT hardware through analogue discovery, component assessment, hardware integration, software creation, and data reconstruction utilizing Gauss-Newton and GREIT approaches. The breast cancer phantom consisted of a gelatin and sodium chloride solution. The position and number of anomalies in the reconstructed image correspond with the phantom. Anomalies in the reconstructed image are illustrated in red, indicating that they exhibit higher conductivity than their environment. The smallest percentage difference in conductivity between the reconstructed image of the cancer abnormality and the phantom is 0.18 %, recorded at a current of 0.35 mA and a frequency of 150 kHz. The smallest percentage difference in size between cancer abnormalities 1 and 2 in the reconstructed image and the phantom is 0.14 %, observed at a current of 0.22 mA and a frequency of 80 kHz. In brief,•This study proposes an innovative Electrical Impedance Tomography (EIT)•The designed and built the Mf-EIT hardware based on data reconstruction using Gauss-Newton and GREIT•The Electrical Impedance Tomography designed to detect the anomalies in the reconstructed image of Breast Cancer.

Objectifying Clinical Outcomes After Lymphaticovenous Anastomosis and Vascularized Lymph Node Transfer in the Treatment of Extremity Lymphedema: A Systematic Review and Meta-Analysis

BACKGROUND

Upper extremity lymphedema (UEL) and lower extremity lymphedema (LEL) can develop as a result of lymph node dissection in the treatment of various malignancies. While emerging microsurgical interventions using lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) show promising outcomes for patients with lymphedema, the best approach to implementing the two procedures remains to be defined. This systematic review and meta-analysis provide a comprehensive overview of published literature on the clinical improvement of extremity lymphedema in patients who undergo either LVA, VLNT, or a combined microsurgical procedure.

METHODS

From Embase, PubMed, and Web of Science databases, 52 studies were identified that met inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions (ROBINS-I) tool and the Cochrane tool for randomized trials (RoB 2).

RESULTS

Random-effects meta-analyses of means estimated a pooled clinical improvement of 36.46% (95% CI: 29.44-43.48) for UEL and 34.16% (95% CI: 23.93-44.40) for LEL. Subgroup analyses revealed differences in clinical improvement according to the microsurgical approach. Clinical improvement of UEL was 29.44% (95% CI: 15.58-43.29) for LVA, 41.66% (95% CI: 34.13-49.20) for VLNT, and 32.80% (95% CI: 21.96-43.64) for combined VLNT + LVA, while the improvement of LEL was 31.87% (95% CI: 18.60-45.14) for LVA and 39.53% (95% CI: 19.37-59.69) for VLNT.

CONCLUSION

The findings from this study elucidate the clinical improvement in extremity lymphedema from various microsurgical approaches. This knowledge could aid physicians in the shared decision-making process with UEL and LEL patients and better facilitate proper patient selection for microsurgical interventions.

Clinical Utility of Bioimpedance Analysis for Upper Limb Lymphedema with Surgical Treatment

Background: In lymphedema, the accumulation of subcutaneous interstitial fluid is the most characteristic feature. Bioimpedance analysis (BIA) is a promising technique to measure the amount of body components using a noninvasive method. In this study, we determined the clinical significance of BIA parameters in upper limb lymphedema with surgical treatment such as lymphovenous anastomosis or vascularized lymph node transfer. Methods and Results: A single-center retrospective study using a multifrequency BIA. Perioperative BIA parameters such as extracellular water ratio or fat-free mass (FFM) ratio and limb volume defined as percentage of excess volume (PEV) were measured. The relationships between the magnitude of change in PEV and BIA parameters during surgery were evaluated. Out of 48 unilateral lymphedema patients, 46 were female and the average age was 55.4 years. PEV and all BIA parameters showed a significant decrease after surgery (p < 0.001). There were significant correlations between ΔPEV and the degree of changes in all BIA parameters. ΔFFM ratio showed the highest correlation with the amount of change in PEV (r = 0.599, p < 0.001). Conclusion: BIA parameters correlated well with the volume change after surgery. BIA could be useful as a quick and easy tool for follow-up after lymphedema surgery.

Contrast-enhanced ultrasonography as an adjunctive method to ICG lymphography for functional lymphaticovenous anastomosis

BACKGROUND AND OBJECTIVES

Indocyanine green (ICG) lymphography is the reference standard for evaluating lymphedema stage and identifying lymphatic vessels. However, the penetration depth was limited to 1-2 cm from the skin surface. This prospective study compares clinical outcomes following lymphaticovenous anastomoses (LVA) in patients with upper and lower limb lymphedema using contrast-enhanced ultrasonography (CEUS) with ICG as a preoperative imaging modality.

METHODS

Under general anesthesia, Sonazoid® was injected subcutaneously to visualize functional lymphatic channels via CEUS. We analyzed the changes in limb circumference and inter-limb ratio (ILR) using bioimpedance to measure electrical resistance between the CEUS plus ICG group and the ICG-only group to see the effect of CEUS-assisted LVA.

RESULTS

No significant demographic differences existed between the two groups (CEUS plus ICG group vs. ICG-only group). The ILR decrease of the Z1 value measured using bioimpedance was statistically significant (p = 0.042 for the upper limb, p = 0.002 for the lower limb)- CONCLUSIONS: CEUS allowed us to identify deep-lying, functional, and large lymphatic channels. In conclusion, the combination of CEUS and ICG for identifying lymphatic channels has the potential to lead to a more functional lymphovenous anastomosis.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.